Neurosurgery Flashcards
When would surgery be indicated for a brain abscess?
> 2.5 cm
mass effect
neurological compromise
failed aspiration or antibiotic treatment
lesions in the cerebellum
known fungal lesions
Describe the key features in the A - E approach for head injuries
C- Spine, choose to collar or not
A- if GCS < 8 intubate , jaw thrust only , avoid nasopharyngeal tubes as there may be facial bone compromise.
B- ensure ventilation and 02 sats
C- HR BP, bloods tests, IVH and IV access
D- formal GCS and repeat every 30 mins, full neuro and cranial nerve exam if conscious , pupillary examination.
E- glucose, temperature, any other injuries : look in the ears, look behing the ears, palpate the whole face and head.
What are some red flag features of a head injury?
Impaired consciousness, local neurological deficits, seizures, visual disturbances, fixed dilated pupil , base of skull fracture nausea and vomiting.
What are key questions to ask about a patient with a head injury?
all about the patient and medical history , anticoags
all about that patients head, Hx of surgery
all about the injury, blunt, penetrating
Extradural hematomas commonly occur from which type of injury?
blunt force trauma, or fall causing bony fracture with minimal displacment
Which artery is the most common to bleed in in extradural haematoma?
middle miningeal artery
What is the timecourse of clinical presentation of someone with extradural haematoma?
head injury with brief LOC, then lucid, then deteriorates.
Other symtpoms may be nausea, vomiting, ot drowsiness.
What initial investigations should you perform to investigate for a Extra dural heamatoma?
Bloods, and CT head (should be able to see the bi-conves lens and a bony fracture)
What is the indication for surgical intervention for extra haematoma?
> 30cm 3, midline shift, GCS
inbetween which layers does a sub dural haematoma occur
tearing of the bridging veins, above the arachnoid matter and below the dura matter
When may symptoms appear post a subdural haematoma?
they can occur immediately or up to months later.
What would a CT scan for a subdural haematoma show?
a convex, cresent shaped, collection of blood in one hemisphere with or without midline shift.
What are the initial management steps for a patient with a head injury
A- E
take a set of bloods and coags, and get brain imaging.
anticoagulaiton reversed
if elderley from fall refer to geriatrics for optimisation.
What are surgical managmenent options for sub dural heamatoma?
raising a bone flat or decompressive craniectmy,
What are some complications post sub dural haematoma?
celebral oedema, raised ICP, seizures, herniation. recurrent haematoma formation is common.
What are the canadian C-Spine rules?
can be used to stratify risk of cervical spine injury following trauma and aid in decision to investigate with imaging.
alert patient with GCS 15
In a stable condition A-E
You need to scan if >65, parasthesia, or high risk mechanism.
You can avoid imaging if they are currently in a sitting position, ambulatory at any time, absence of midline tenderness, delayed onset neck pain.
then carry out a ROM assessment on the neck.
When woudl surgery be indicated for a spinal fracture?
displacement, instability or neurology
What is the investigation and treatment for hydrocephalus?
Ct head. treat with ventriculoperitoneal shunt
What is the normal range for intracranial pressure?
5-15. Intervene at 20 mmHg due to severe life threatening consequences.
cerebral perfusion pressure is calculated by what?
Mean Arterial Pressure minus Intracranial Pressure
What examination findings would you find in raised ICP? early and late
Early: papillary signs, occular muscle palsies, pappiloedema,
Late: vomiting without nausea, cushings triad (irregular breathing, bradycardia and hypertension), othalmoplegia, coma, death.
What are the two devices used for monitoring intracranial pressure?
sub-arachoid bolt (ICP data only) and the external ventricular drain which can monitor pressure and drain and sample fluid
What immediate management can you offer a patient with an intracerebral bleed?
stabilise and resusitate
need to get BP down
reverse anticoagulation
anti-seizure prophylaxis
When is surgical management recommended for an intracerebral stroke?
cerebellar bleeds, craniotomy and craniectomy
